Quadruple Valve Replacement for Behçet's Syndrome: A Case Report.

Area of Science:

• Cardiovascular Surgery
• Autoimmune Diseases
• Vascular Biology

Background:

• Behcet's syndrome is a systemic autoimmune vasculitis frequently causing cardiovascular complications like valvular damage and aortic root pseudoaneurysms.
• Concurrent involvement of all four cardiac valves is rare and presents significant surgical challenges due to tissue fragility and inflammation.

Purpose of the Study:

• To detail a specialized surgical strategy for quadruple valve replacement in a Behcet's syndrome patient with extensive valvular lesions and aortic root pseudoaneurysm.
• To emphasize techniques addressing anatomical complexity and facilitating future transcatheter interventions.

Main Methods:

• A 51-year-old female with Behcet's syndrome underwent reoperation for aortic root pseudoaneurysm, paravalvular leaks, and severe mitral/tricuspid regurgitation.
• Key techniques included radical debridement, annular enlargement, a modified "chimney" Commando-Bentall hybrid procedure, and a "Sandwich" technique for aortic root reconstruction.

Main Results:

• The surgery was successful, with uneventful recovery and discharge on postoperative day 30.
• Six-month follow-up confirmed patient survival, stable valve function, and no recurrent leaks.
• Dual annular enlargement facilitated larger prostheses, reducing mismatch and preserving options for future transcatheter valve implantation (TAVI).

Conclusions:

• This approach demonstrates the feasibility of combining annular enlargement, root reinforcement, and bioprosthetic valve replacement in Behcet's syndrome with pan-valvular involvement.
• The hybrid chimney-Bentall technique and meticulous root reconstruction address inflammatory tissue vulnerability while enabling future minimally invasive interventions.